Obesity

Last updated 1 Jun 2026 · General Practice / Endocrinology

📋 Key Information Summary

📋

Obesity is defined as a BMI ≥ 30 kg/m²; in Aboriginal and Torres Strait Islander peoples, a lower BMI threshold (≥ 27.5 kg/m²) is used to reflect increased cardiometabolic risk at lower body mass.
Waist circumference is a critical adjunct to BMI — thresholds ≥ 94 cm (men) / ≥ 80 cm (women) indicate increased cardiometabolic risk regardless of BMI.
Secondary causes must be excluded before attributing obesity to lifestyle alone — hypothyroidism, Cushing syndrome, PCOS, hypothalamic injury, and medications (corticosteroids, antipsychotics, insulin, sulfonylureas) are key differentials.
The 5As model (Ask, Assess, Advise, Agree, Assist) is the recommended framework for structured obesity conversations in Australian general practice (RACGP).
Behavioural counselling targeting ≥ 150 minutes/week moderate-intensity physical activity and a 2,500 kJ/day (≈ 600 kcal/day) energy deficit is first-line management for all patients.
Calorie counting using food diaries or apps (e.g., Easy Diet Diary, MyFitnessPal) improves weight-loss outcomes when combined with dietitian-led dietary counselling.
Pharmacotherapy is indicated for BMI ≥ 30 (or ≥ 27 with comorbidities) who have not achieved ≥ 5% weight loss after 3–6 months of lifestyle intervention — options include phentermine, liraglutide (Saxenda®), semaglutide (Wegovy®), and orlistat.
Bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric band) should be considered for BMI ≥ 40 (or ≥ 35 with comorbidities) after failed intensive medical therapy; referral to an accredited MDT bariatric service is required.
Post-bariatric patients require lifelong nutritional monitoring — vitamin B12, iron, folate, calcium, vitamin D, and thiamine deficiencies are common and must be screened for at least annually.
Aboriginal and Torres Strait Islander communities experience obesity prevalence 1.6 times the general population; culturally safe, community-controlled health service models and Yarning-based counselling improve engagement.
Obesity in pregnancy increases the risk of GDM, pre-eclampsia, caesarean delivery, and macrosomia — gestational weight gain targets should be individualised using IOM guidelines.
MBS items 721 (GP Management Plan), 723 (Team Care Arrangement), 732 (Aboriginal Health Check), and allied health Medicare rebates (up to 5 sessions/year) support structured obesity management in primary care.

Introduction & Australian Epidemiology

Obesity is a chronic, relapsing, multifactorial disease characterised by excess adiposity that impairs health. It is the leading preventable cause of premature death in Australia and a major driver of type 2 diabetes, cardiovascular disease, certain cancers, musculoskeletal disorders, and mental health morbidity. General practitioners are ideally placed to initiate, coordinate, and sustain obesity management through longitudinal patient relationships.

According to the Australian Institute of Health and Welfare (AIHW, 2023), two in three Australian adults (67%) are overweight or obese (BMI ≥ 25 kg/m²), and one in three (31%) are obese (BMI ≥ 30 kg/m²). The prevalence has risen steadily over the past three decades, with rural and remote populations disproportionately affected. Obesity accounts for an estimated 7.4% of total health expenditure in Australia and is projected to cost the economy over billion annually by 2025.

In Aboriginal and Torres Strait Islander peoples, the prevalence of obesity is approximately 1.6 times that of non-Indigenous Australians, with rates highest in remote and very remote communities. Childhood obesity affects 8.2% of Australian children (2–17 years), and rates are substantially higher among First Nations children. These disparities reflect the broader social determinants of health — food insecurity, limited access to affordable nutritious food, housing instability, and reduced access to primary care services.

This article provides a practical, evidence-based framework for the assessment and management of obesity in Australian general practice, covering classification, secondary causes, behaviour change strategies, dietary management, pharmacotherapy, bariatric surgery, special populations, and culturally safe care for Aboriginal and Torres Strait Islander peoples.

⚠️

Key distinction: Obesity is recognised as a chronic disease by the World Health Organization, the Australian Medical Association, and the Royal Australian College of General Practitioners. Framing obesity as a disease — not a lifestyle choice — reduces stigma and improves patient engagement with treatment.

BMI Classification & Secondary Causes

BMI Classification

Body mass index (BMI) is calculated as weight (kg) divided by height (m) squared. It remains the most widely used population-level screening tool for adiposity, though it does not distinguish between lean mass and fat mass, nor does it reflect fat distribution.

Category	General Population BMI (kg/m²)	ATSI Population BMI (kg/m²)	Risk Level
Underweight	< 18.5	< 18.5	Increased (malnutrition, osteoporosis)
Normal weight	18.5 – 24.9	18.5 – 24.9	Low (healthy range)
Overweight	25.0 – 29.9	25.0 – 27.4	Increased
Obese — Class I	30.0 – 34.9	27.5 – 32.4	High
Obese — Class II	35.0 – 39.9	32.5 – 37.4	Very high
Obese — Class III (severe)	≥ 40.0	≥ 37.5	Extreme

💡

Waist circumference thresholds for increased cardiometabolic risk: Men ≥ 94 cm (increased), ≥ 102 cm (substantially increased); Women ≥ 80 cm (increased), ≥ 88 cm (substantially increased). These apply to the general population; lower cut-points may apply to Asian and South Asian populations. Measure at the midpoint between the lowest rib and the iliac crest, at the end of a normal expiration.

Secondary Causes of Obesity

A thorough history and targeted investigation should exclude secondary causes before attributing obesity to primary (simple) obesity. Medication review is essential — many commonly prescribed drugs promote weight gain.

Category	Conditions / Agents	Key Screening Investigations
Endocrine	Hypothyroidism, Cushing syndrome/syndrome, polycystic ovarian syndrome (PCOS), growth hormone deficiency, hypogonadism	TSH, free T4; 24-hr urinary cortisol or overnight dexamethasone suppression test; LH, FSH, testosterone, SHBG; IGF-1
Hypothalamic	Craniopharyngioma, post-traumatic hypothalamic injury, Prader–Willi syndrome	MRI pituitary/hypothalamus; genetic testing if syndromic features
Genetic / syndromic	Prader–Willi, Bardet–Biedl, Alström, MC4R deficiency, leptin deficiency	Genetic referral; plasma leptin level
Medication-induced	Corticosteroids, antipsychotics (olanzapine, clozapine, quetiapine), antidepressants (mirtazapine, paroxetine), anticonvulsants (sodium valproate, carbamazepine), insulin, sulfonylureas, beta-blockers, some antiretrovirals	Comprehensive medication review; consider alternative agents
Psychological	Binge eating disorder, bulimia nervosa, depression, ADHD-related impulsivity	PHQ-9, BED screener, referral to psychologist/psychiatrist
Sleep-related	Obstructive sleep apnoea (bidirectional relationship), shift work disorder	STOP-BANG questionnaire; polysomnography referral

⚠️

Red flags requiring urgent endocrine referral: Rapid onset obesity (> 10 kg in 6 months), central obesity with proximal muscle weakness and striae (Cushing), headaches with visual field defects (hypothalamic/pituitary mass), unexplained growth failure in a child.

Encouraging Behaviour Change — The 5As Model

The RACGP recommends the 5As framework (Ask, Assess, Advise, Agree, Assist) as a structured approach to obesity counselling in general practice. It provides a stepwise, non-judgemental, patient-centred pathway that can be delivered across multiple consultations and is supported by MBS items for chronic disease management.

ASK

Raise the topic sensitively. Use open-ended questions: "How do you feel about your weight?" Measure BMI and waist circumference at every relevant consultation. Ask about readiness to change (pre-contemplation, contemplation, preparation, action). Avoid blame or shame — acknowledge structural barriers (food deserts, shift work, caring responsibilities).

ASSESS

Quantify BMI class and waist circumference. Screen for comorbidities: type 2 diabetes (HbA1c, fasting glucose), dyslipidaemia (lipid panel), NAFLD (LFTs, FIB-4), hypertension, OSA, PCOS, depression (PHQ-9), and osteoarthritis. Assess readiness, motivation, and barriers. Use the Australian Physical Activity Questionnaire or a simple screening question about activity levels.

ADVISE

Provide clear, personalised health advice linking weight to the patient's specific comorbidities. A modest 5% weight loss produces clinically meaningful improvements in blood pressure, glycaemic control, lipids, and sleep apnoea severity. Use motivational interviewing techniques — reflective listening, affirmations, summaries, and open questions (OARS).

AGREE

Collaboratively set SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound). Example: "I will walk for 30 minutes after dinner on Monday, Wednesday, and Friday for the next 4 weeks." Develop a GP Management Plan (MBS 721) and Team Care Arrangement (MBS 723) to enable allied health referrals.

ASSIST

Refer to multidisciplinary team: dietitian (individualised meal planning, MBS-rebated), exercise physiologist (graded activity prescription), psychologist (CBT for emotional eating, binge eating disorder), bariatric physician or endocrinologist (pharmacotherapy, complex cases). Link to community programmes (Life! Program in Victoria, My Health for Life in Queensland). Schedule regular follow-up — 2–4 weekly initially, then 3-monthly for maintenance.

Motivational Interviewing — Practical Tips

Express empathy: "It sounds like managing your weight has been really challenging, especially with your work schedule."
Develop discrepancy: "You mentioned wanting to be around for your grandchildren — how does your current weight affect that goal?"
Roll with resistance: Avoid argumentation. If a patient resists, explore: "What concerns do you have about making changes?"
Support self-efficacy: "You've already cut down on sugary drinks — that takes real effort. What else do you think you could try?"
Use the readiness ruler: "On a scale of 1–10, how ready are you to make changes to your eating habits? What would it take to move from a 4 to a 6?"

✅

MBS support for obesity management: MBS Item 721 (GPMP) and 723 (TCA) allow up to 5 allied health sessions per calendar year. Aboriginal and Torres Strait Islander Health Checks (MBS 715/732) include weight and waist measurement, dietary assessment, and physical activity screening. Chronic disease dental services (MBS 85011) may also be relevant where obesity-related comorbidities are present.

Calorie Counting & Dietary Management

Dietary intervention is the cornerstone of obesity management. The fundamental principle is achieving a sustained energy deficit — typically 2,500 kJ/day (approximately 600 kcal/day) below estimated energy requirements — to produce a weight loss of approximately 0.5–1.0 kg/week. There is no single "best diet"; the optimal dietary pattern is one the patient can adhere to long-term.

Principles of Dietary Management

Energy deficit: Calculate basal metabolic rate (using Schofield or Harris–Benedict equations) and total daily energy expenditure, then subtract 2,500 kJ/day. This typically equates to 5,000–7,500 kJ/day for most adults.
Macronutrient balance: No single macronutrient ratio is superior for weight loss. The Australian Dietary Guidelines (NHMRC, 2013) recommend: 45–65% carbohydrates (prioritising wholegrains), 20–35% fat (emphasising unsaturated fats), 15–25% protein (≥ 1.0–1.2 g/kg/day to preserve lean mass during weight loss).
Protein adequacy: Higher protein intake (25–30% of total energy) improves satiety and preserves lean body mass during energy restriction. Include lean meats, poultry, fish, eggs, legumes, tofu, and dairy at each meal.
Fibre: Target ≥ 25 g/day (women) or ≥ 30 g/day (men) from vegetables, fruits, legumes, and wholegrains to improve satiety and gut health.
Ultra-processed foods: Reduce intake of energy-dense, nutrient-poor foods — sugar-sweetened beverages, confectionery, fried foods, processed meats, and packaged snacks. These foods bypass satiety signalling and drive passive overconsumption.
Hydration: Encourage water as the primary beverage. Limit fruit juice (even 100% juice is energy-dense). Avoid liquid calories.

Calorie Counting — Practical Approaches

Calorie counting (also termed energy tracking) involves recording all food and drink consumed to raise awareness of actual intake versus estimated targets. Evidence shows that self-monitoring is one of the strongest predictors of successful weight loss and maintenance.

Digital Tools (Preferred)

Easy Diet Diary (Australian-developed, uses AUSNUT food composition database, free)
MyFitnessPal (large food database, free basic version)
Cronometer (detailed micronutrient tracking)
Barcode scanning features simplify entry for packaged foods
Most apps generate daily/weekly summaries showing energy, macronutrient, and micronutrient intake

Paper-Based Methods

3-day food diary (2 weekdays + 1 weekend day) reviewed by dietitian
Photographic food diary (taking photos before eating) — less burdensome, good for patients with low literacy
Traffic-light food diary (green = freely eat; amber = moderate; red = limit)

Evidence-Based Dietary Patterns

Dietary Pattern	Key Features	Evidence	Considerations
Mediterranean diet	Olive oil, fish, legumes, wholegrains, vegetables, fruits, nuts; moderate wine	PREDIMED trial — significant CVD risk reduction; modest weight loss benefit	Best evidence for cardiometabolic outcomes; culturally adaptable
Low-carbohydrate (< 130 g/day)	Reduced grains, sugars; higher protein and fat	Short-term (< 12 months) weight loss superior to low-fat; equivalent long-term	Useful for T2DM management; monitor lipids; caution with CKD
Very low-calorie diet (VLCD)	3,300–4,200 kJ/day (800–1,000 kcal); meal replacement products	Rapid initial weight loss; higher regain rate without maintenance programme	Medical supervision required; contraindicated in severe CKD, pregnancy, eating disorders
Intermittent fasting (5:2 or 16:8)	Alternate-day or time-restricted eating	Comparable weight loss to continuous energy restriction at 12 months	May suit some patients' preferences; caution with hypoglycaemia-prone diabetes
DASH diet	Low sodium, high fruit/vegetable, low saturated fat	Primarily for hypertension; modest weight loss benefit	Best for patients with concurrent hypertension

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Dietitian referral is strongly recommended. A 45-minute initial dietitian consultation enables individualised meal planning, cultural dietary considerations (including traditional Aboriginal and Torres Strait Islander foods), budget-sensitive recommendations, and ongoing food diary review. MBS-rebated via GPMP/TCA (up to 5 sessions/year).

Pharmacotherapy for Obesity

Pharmacotherapy is an adjunct to — not a replacement for — lifestyle intervention. It should be considered when a patient with BMI ≥ 30 (or ≥ 27 with comorbidities) has not achieved ≥ 5% weight loss after 3–6 months of structured diet and physical activity intervention. Medication choice should be individualised based on comorbidities, side-effect profile, patient preference, cost, and PBS status.

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Phentermine

Duromine® · Metermine® · Sympathomimetic amine anorectic

Mechanism Noradrenaline release in hypothalamus → appetite suppression

Adult dose 15–30 mg PO mane (morning); titrate from 15 mg; maximum 3 months per course

Paediatric dose Not recommended < 18 years

Renal adjustment Caution in CKD; dose reduction may be required

Hepatic adjustment Avoid in severe hepatic impairment

Key side effects Insomnia, dry mouth, tachycardia, hypertension, anxiety, constipation

Contraindications CVD, uncontrolled hypertension, hyperthyroidism, MAOIs within 14 days, glaucoma, history of drug abuse

PBS status ✖ Not PBS listed (Private prescription; ~–120/month)

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Liraglutide 3.0 mg

Saxenda® · GLP-1 receptor agonist

Mechanism GLP-1 receptor agonist → satiety signalling, delayed gastric emptying, reduced appetite

Adult dose Start 0.6 mg SC daily; increase by 0.6 mg weekly → target 3.0 mg SC daily

Paediatric dose ≥ 12 years: same titration schedule (TGA-approved for adolescent obesity)

Renal adjustment Caution in severe CKD (eGFR < 30); monitor for dehydration from GI side effects

Hepatic adjustment No specific dose adjustment; use with caution

Key side effects Nausea (39%), vomiting, diarrhoea, constipation, injection site reactions; rare: pancreatitis, gallbladder disease

Contraindications Personal/family history of medullary thyroid carcinoma, MEN2; history of pancreatitis

PBS status ✖ Not PBS listed (Private prescription; ~0–380/month)

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Semaglutide 2.4 mg

Wegovy® · GLP-1 receptor agonist

Mechanism Long-acting GLP-1 RA → potent appetite suppression, reduced food cravings, central reward pathway modulation

Adult dose Start 0.25 mg SC weekly × 4 weeks → 0.5 mg weekly × 4 weeks → 1.0 mg weekly × 4 weeks → 1.7 mg weekly × 4 weeks → maintenance 2.4 mg weekly

Paediatric dose Not yet TGA-approved for < 18 years in Australia (approved by FDA in USA for ≥ 12 years)

Renal adjustment Caution in severe CKD; monitor renal function

Key side effects Nausea (44%), vomiting, diarrhoea, constipation, headache; rare: pancreatitis, gallbladder disease

Evidence STEP trials: mean weight loss 14.9% at 68 weeks vs 2.4% placebo; superior to all other anti-obesity medications

PBS status ✖ Not PBS listed (Private prescription; ~0–450/month)

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Orlistat

Xenical® · Generic · Pancreatic lipase inhibitor

Mechanism Inhibits pancreatic and gastric lipase → reduces dietary fat absorption by ~30%

Adult dose 120 mg PO TDS with each main meal (or up to 1 hour after); omit if meal is fat-free

Paediatric dose ≥ 12 years: same adult dose

Renal adjustment No dose adjustment; monitor oxalate nephropathy risk

Key side effects Steatorrhoea, faecal urgency, flatulence, oily spotting; fat-soluble vitamin malabsorption (A, D, E, K)

Contraindications Cholestasis, chronic malabsorption syndrome

PBS status ✔ PBS General Benefit (Authority required; ~–50/month with PBS)

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Naltrexone/bupropion

Contrave® · Opioid antagonist + noradrenaline/dopamine reuptake inhibitor

Mechanism Naltrexone blocks opioid-mediated reward from food; bupropion stimulates POMC anorectic pathway

Adult dose Week 1: 1 tablet (8/90 mg) PO mane; Week 2: 1 tablet BD; Week 3: 2 tablets mane + 1 tablet PM; Week 4 onwards: 2 tablets BD (32/360 mg/day)

Paediatric dose Not recommended < 18 years

Renal adjustment eGFR 15–30: maximum 2 tablets/day; eGFR < 15: avoid

Key side effects Nausea (33%), constipation, headache, insomnia, dry mouth, dizziness; rare: seizure (0.1%)

Contraindications Uncontrolled hypertension, seizure disorder, concurrent opioids, bulimia/anorexia, MAOIs, abrupt alcohol/benzodiazepine cessation

PBS status ✖ Not PBS listed (Private prescription; ~0–200/month)

🚨

Safety critical: Anti-obesity medications are not recommended in pregnancy. Women of childbearing age should use effective contraception during treatment and for at least 2 months after stopping semaglutide/liraglutide (due to potential teratogenicity and long half-life). Phentermine is absolutely contraindicated in pregnancy.

Bariatric Surgery Considerations

Bariatric (metabolic and weight-loss) surgery is the most effective intervention for sustained long-term weight loss in patients with severe obesity. It produces durable weight loss of 15–35% of total body weight (depending on procedure), remission of type 2 diabetes in up to 60–80% of cases, and significant reductions in all-cause mortality, cardiovascular events, and cancer incidence.

Indications for Referral

📋

BMI ≥ 40 kg/m² (or ≥ 37.5 in ATSI populations), OR
BMI ≥ 35 kg/m² (or ≥ 32.5 in ATSI populations) with at least one obesity-related comorbidity (type 2 diabetes, OSA, hypertension, NAFLD/NASH, severe osteoarthritis, urinary stress incontinence)
AND failure to achieve adequate weight loss with ≥ 6 months of structured, multidisciplinary medical therapy (lifestyle ± pharmacotherapy)
AND patient demonstrates understanding of the need for lifelong dietary modification, supplementation, and follow-up
For T2DM with BMI ≥ 30: consider metabolic surgery even without failed medical therapy (ADA/IDF joint statement, endorsed by ANZMOSS)

Surgical Procedures

Procedure	Mechanism	% Excess Weight Loss (5 yr)	T2DM Remission	Key Risks
Sleeve gastrectomy (LSG)	Restrictive: removes ~80% of stomach; reduces ghrelin production	60–70%	60–65%	Staple line leak (1–3%), GERD (new-onset 20–30%), sleeve stricture
Roux-en-Y gastric bypass (RYGB)	Restrictive + malabsorptive: small gastric pouch + bypassed duodenum/proximal jejunum	65–75%	75–80%	Anastomotic leak (1–2%), internal hernia (2–5%), dumping syndrome, marginal ulcer, nutritional deficiencies
Adjustable gastric band (AGB)	Restrictive: silicone band around upper stomach	40–50%	30–40%	Band slippage/erosion (5–10%), port complications, insufficient weight loss; declining popularity
Biliopancreatic diversion ± duodenal switch (BPD/DS)	Primarily malabsorptive with restrictive component	70–80%	85–90%	Severe malnutrition, protein deficiency, fat-soluble vitamin deficiency, dumping; reserved for super-obesity (BMI > 50–60)

Pre-Operative Assessment (GP Role)

Optimise comorbidities: HbA1c < 53 mmol/mol (7%) if achievable; blood pressure < 140/90 mmHg; smoking cessation ≥ 6 weeks pre-operatively (mandatory); OSA diagnosed and treated (CPAP).
Psychological assessment: Refer for pre-operative psychological evaluation — screen for untreated binge eating disorder, unmanaged depression/anxiety, unrealistic expectations, and lack of social support.
Medication review: Cease or convert insulin where possible (high risk of post-operative hypoglycaemia). Review anticoagulation, NSAIDs (contraindicated post-RYGB due to marginal ulcer risk), and oral contraceptives (consider alternative due to impaired absorption post-RYGB).
Nutritional baseline: Full nutritional panel: FBC, iron studies (ferritin, transferrin saturation), vitamin B12, folate, vitamin D (25-OH), calcium, PTH, zinc, thiamine, vitamin A, vitamin E, liver function tests, albumin, lipase.
Pre-operative liver assessment: Ultrasound for NAFLD; LFTs. A severely fatty liver may require a pre-operative very low-calorie diet (2–4 weeks) to reduce liver volume and improve surgical access.

Post-Operative Follow-Up (GP Role — Lifelong)

Bariatric surgery is a lifelong commitment. GPs play a critical role in monitoring for nutritional deficiencies, weight regain, and psychological changes. Follow-up should be coordinated with the bariatric surgical team, dietitian, and psychologist.

0–6 weeks

Clear fluids → pureed diet → soft diet progression. Monitor for surgical complications (leak, DVT/PE). Start micronutrient supplementation (bariatric-specific multivitamin, calcium citrate 1200 mg/day, vitamin D 1000 IU/day, vitamin B12 1000 mcg IM monthly or 1000 mcg oral daily post-RYGB). Thiamine 100 mg PO daily if prolonged vomiting.

3 months

Dietitian review. Assess protein intake (≥ 60–80 g/day). Full nutritional bloods: FBC, iron studies, B12, folate, vitamin D, calcium, PTH, zinc, thiamine. Assess for dumping syndrome management.

6 months

Assess weight trajectory (expected nadir at 12–18 months). Review diabetes medications — many patients achieve remission and can cease insulin/sulfonylureas. Monitor for reactive hypoglycaemia (post-bariatric hyperinsulinaemic hypoglycaemia).

12 months

Full nutritional bloods. Assess for weight plateau or regain. Psychological wellbeing review. Body contouring referral if desired (massive weight loss).

Annual (lifelong)

Annual nutritional bloods: FBC, iron studies, B12, folate, vitamin D, calcium, PTH, zinc, copper, thiamine, vitamin A, vitamin E, liver function, albumin, lipids, HbA1c. Bone density (DEXA) at 2 years and as indicated. Reinforce supplementation adherence — non-adherence to lifelong supplementation is the most common cause of preventable post-bariatric complications.

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Critical post-bariatric deficiency: Thiamine (vitamin B1) deficiency can develop rapidly (within weeks) post-operatively, especially with persistent vomiting. Present as Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) — this is a medical emergency requiring immediate IV thiamine (Pabrinex®) 300 mg IV TDS for 3–5 days before switching to oral. Do not give glucose before thiamine.

Investigations

A baseline investigation panel should be performed for all patients presenting with obesity to screen for comorbidities, exclude secondary causes, and establish a pre-treatment baseline.

Essential

BMI, waist circumference, blood pressure

Measure at every visit. Use calibrated scales and stadiometer. Measure waist at midpoint between lowest rib and iliac crest, end-expiration.

Essential

Fasting glucose and HbA1c

Screen for type 2 diabetes and pre-diabetes. HbA1c ≥ 48 mmol/mol (6.5%) = diagnostic for T2DM. 42–47 mmol/mol = pre-diabetes. MBS items available.

Essential

Fasting lipid profile

Total cholesterol, LDL, HDL, triglycerides. Assess for dyslipidaemia (common in metabolic syndrome). Fasting sample preferred.

Essential

Thyroid function (TSH ± free T4)

Rule out hypothyroidism as a secondary cause. TSH alone is sufficient in most cases; add free T4 if TSH abnormal.

Essential

Liver function tests (LFTs)

ALT, AST, GGT, ALP, bilirubin, albumin. Elevated ALT > 2× ULN warrants FIB-4 calculation and NAFLD assessment. Available via MBS.

Available

FIB-4 score (calculated)

FIB-4 = (Age × AST) / (Platelet count × √ALT). Scores < 1.3 = low risk of advanced fibrosis; > 2.67 = high risk → refer to hepatologist. Uses routine bloods — no additional cost.

Available

Renal function (eGFR, urine ACR)

Screen for CKD, especially in patients with concurrent T2DM or hypertension. Urine ACR for microalbuminuria.

Available

Serum cortisol (overnight dexamethasone suppression test)

If clinical suspicion of Cushing syndrome: central obesity, purple striae, proximal myopathy, easy bruising, facial plethora. 1 mg overnight DST — morning cortisol < 50 nmol/L = normal suppression.

Available

PCOS screen (if applicable)

LH, FSH, total testosterone, SHBG, DHEA-S. Pelvic ultrasound (ovarian morphology). Indicated in women with oligo/amenorrhoea, hirsutism, acne.

Specialist

Polysomnography (sleep study)

If STOP-BANG ≥ 3, excessive daytime sleepiness, or witnessed apnoeas. Available via sleep physician or accredited sleep lab referral. Bulk-billed in most public sleep labs.

Specialist

Genetic testing

For suspected syndromic obesity (Prader–Willi, Bardet–Biedl) or severe early-onset obesity. Requires clinical genetics referral.

Risk Stratification & Comorbidity Assessment

Stratifying patients by risk level guides the intensity of intervention — from brief GP counselling for low-risk overweight to multidisciplinary bariatric referral for severe obesity with multiple comorbidities.

Low–Moderate Risk

Overweight / Obesity Class I (no comorbidities)

BMI 25–34.9 kg/m² with normal waist circumference and no cardiometabolic comorbidities. Often asymptomatic.

Setting: General practice — 5As counselling, dietitian referral, GPMP/TCA, community programmes

High Risk

Obesity Class I–II with ≥ 1 comorbidity

BMI 30–39.9 with type 2 diabetes, hypertension, dyslipidaemia, OSA, NAFLD, PCOS, or osteoarthritis. Increased waist circumference. Quality-of-life impairment.

Setting: General practice + MDT — consider pharmacotherapy (phentermine, orlistat, GLP-1 RA), specialist referral for comorbidity management, exercise physiology, psychology

Very High Risk

Obesity Class II–III with multiple comorbidities

BMI ≥ 35 with ≥ 2 comorbidities, or BMI ≥ 40 regardless. Severe functional impairment, disability, recurrent hospitalisations, obesity-related heart failure, severe OSA.

Setting: Bariatric surgical referral assessment, intensive MDT, specialist physician (endocrinologist, respiratory physician), consider GLP-1 RA (liraglutide/semaglutide) or bariatric surgery pathway

Monitoring

Regular monitoring is essential to maintain motivation, detect complications early, and adjust management. A structured follow-up schedule supports sustained engagement.

Parameter	Frequency	Target / Notes
Weight, BMI, waist circumference	Every 2–4 weeks (initial); every 1–3 months (maintenance)	≥ 5% weight loss at 3–6 months = clinically significant; ≥ 10% for comorbidity improvement
Blood pressure	Every visit	< 130/80 mmHg if comorbid T2DM or CKD; < 140/90 mmHg otherwise
HbA1c, fasting glucose	3-monthly (if diabetic/pre-diabetic); 6–12-monthly (if normal)	HbA1c target < 53 mmol/mol (7%) for T2DM; < 42 mmol/mol to exclude progression from pre-diabetes
Lipid profile	3–6 months after treatment initiation; then annually	Individualised CV risk-based targets; consider absolute CV risk calculator (Australian CVD Risk Calculator)
LFTs	6-monthly (if NAFLD); annually (otherwise)	ALT normalisation with weight loss; monitor for drug-induced hepatotoxicity if on pharmacotherapy
Renal function, urine ACR	Annually (more frequently if CKD)	Monitor for progression; adjust medications accordingly
Nutritional markers (post-bariatric)	3-monthly (year 1); annually (lifelong)	Iron studies, B12, folate, vitamin D, calcium, PTH, zinc, thiamine, vitamin A, copper
PHQ-9 / K10 (psychological wellbeing)	Every 3–6 months	Screen for depression, anxiety; assess relationship with food and body image
Physical activity	Every visit	Target ≥ 150 min/week moderate-intensity or ≥ 75 min/week vigorous-intensity; ≥ 2 sessions resistance training
Medication adherence	Every visit	Assess tolerability, side effects, refill frequency; reinforce that weight regain is common on cessation

Special Populations

🤰

Pregnancy

Pre-conception counselling Achieve weight loss before conception where possible. Cease all anti-obesity medications ≥ 2 months (phentermine, orlistat) or ≥ 2 months (GLP-1 RAs) before conception. Post-bariatric patients should delay pregnancy ≥ 12–18 months after surgery to allow weight stabilisation and nutritional repletion.

Gestational weight gain Follow IOM (2009) guidelines: BMI 25–29.9 → gain 7–11.5 kg; BMI ≥ 30 → gain 5–9 kg. Excessive GWG increases GDM, pre-eclampsia, macrosomia, and caesarean delivery risk.

GDM screening Offer OGTT at 24–28 weeks to all women with BMI ≥ 30; earlier screening if additional risk factors (previous GDM, family history, PCOS, ATSI background).

Post-partum Support breastfeeding (promotes post-partum weight loss). Resume weight management plan at 6-week postnatal check. Reassess pharmacotherapy if not breastfeeding.

👶

Paediatrics

Definition Overweight: BMI ≥ 85th percentile for age/sex; Obesity: BMI ≥ 95th percentile. Use WHO growth charts for children < 5 years and CDC/Australian growth charts for 5–19 years.

Management approach Whole-family behavioural intervention is first-line. Target: stabilise weight while the child grows taller (rather than weight loss per se in pre-pubertal children). Limit screen time to < 2 hours/day. Encourage ≥ 60 minutes moderate-to-vigorous physical activity daily.

Pharmacotherapy Liraglutide (Saxenda®) is TGA-approved for ≥ 12 years. Orlistat approved for ≥ 12 years. Phentermine is not recommended < 18 years. Semaglutide (Wegovy®) is approved by FDA for ≥ 12 years but not yet TGA-approved in this age group in Australia.

Bariatric surgery Consider in adolescents ≥ 15 years with BMI ≥ 40 (or ≥ 35 with severe comorbidities) after multidisciplinary assessment. Performed only at accredited adolescent bariatric centres.

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Elderly (≥ 65 years)

Reframed goals In older adults, aggressive weight loss may increase frailty, sarcopenia, and fall risk. Focus on maintaining functional independence, preventing further weight gain, adequate protein intake (1.0–1.2 g/kg/day), and resistance training to preserve muscle mass.

BMI interpretation A slightly elevated BMI (25–30) may be protective in the elderly ("obesity paradox"). BMI < 23 is associated with increased mortality in over-65s. Use clinical judgement and consider body composition rather than BMI alone.

Pharmacotherapy caution Phentermine is relatively contraindicated (cardiovascular risk). GLP-1 RAs require caution with GI side effects and dehydration risk. Orlistat may worsen faecal incontinence. Start low, go slow.

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Renal Impairment

CKD staging Obesity is both a cause and consequence of CKD. Glomerular hyperfiltration from excess body mass leads to obesity-related glomerulopathy. Monitor eGFR and urine ACR regularly.

Dietary considerations In CKD stages 3b–5, balance energy deficit with protein restriction (0.6–0.8 g/kg/day for non-dialysis CKD) under renal dietitian guidance. Avoid very low-calorie diets if eGFR < 30.

Medication adjustments Phentermine: caution, dose reduction. Orlistat: monitor oxalate nephropathy risk. GLP-1 RAs: caution in severe CKD. Contrave: maximum 2 tablets/day if eGFR 15–30; avoid if < 15.

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Hepatic Impairment

NAFLD / NASH NAFLD affects up to 60% of people with obesity. Calculate FIB-4 score to assess fibrosis risk. Weight loss of ≥ 7–10% of body weight can reverse steatosis and improve NASH histology. Refer to hepatologist if FIB-4 > 2.67 or if advanced fibrosis is suspected.

Medication considerations Avoid phentermine in severe hepatic impairment. Orlistat: caution in cholestasis. GLP-1 RAs: use with caution; monitor LFTs. Semaglutide may have hepatoprotective effects in NASH (emerging evidence from semaglutide NASH trials).

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Immunocompromised

Corticosteroid-induced weight gain Chronic corticosteroid use (transplant, autoimmune disease) causes central obesity, insulin resistance, and metabolic syndrome. Minimise steroid dose where possible. Consider steroid-sparing agents. Metformin may help counter steroid-induced hyperglycaemia and weight gain.

HIV-related lipodystrophy Central obesity with peripheral lipoatrophy may occur with older antiretrovirals. Switch to modern regimens (integrase inhibitors). Manage per standard metabolic guidelines.

Immunosuppressant interactions Tacrolimus and cyclosporine may interact with metabolic pathways. Coordinate with transplant team before initiating anti-obesity pharmacotherapy.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health

Epidemiology

Aboriginal and Torres Strait Islander adults are 1.6 times more likely to be obese than non-Indigenous Australians. In remote communities, obesity prevalence exceeds 40%. Childhood obesity rates are 1.5–2 times higher among First Nations children. Obesity is a key driver of the gap in life expectancy between Indigenous and non-Indigenous Australians.

Lower BMI thresholds

Use ATSI-specific BMI cut-points: overweight ≥ 25 (same) but obesity class I from ≥ 27.5 kg/m² (vs 30). These lower thresholds reflect the increased cardiometabolic risk observed at lower BMI in First Nations populations, consistent with NHMRC and AIHW recommendations.

Social determinants

Food insecurity is a major driver — remote communities often pay 2–3 times more for healthy food than urban areas. The absence of affordable fresh produce, reliance on shelf-stable processed foods, limited refrigeration, and housing overcrowding all contribute. Healthy food baskets in remote NT communities cost up to 40% of income for welfare-dependent families.

Culturally safe care

Use Yarning-based consultations — a culturally grounded communication approach that builds trust, shared understanding, and patient autonomy. Acknowledge the impact of intergenerational trauma, racism, and colonisation on health behaviours. Avoid paternalistic language. Aboriginal Health Workers and Practitioners (AHWPs) are essential members of the care team.

Community-controlled health services

Aboriginal Community Controlled Health Organisations (ACCHOs) deliver integrated, holistic care that addresses obesity within the broader social and cultural context. Referral to ACCHO-based dietitians, exercise programmes, and chronic disease management teams improves engagement and outcomes. The Close the Gap PBS co-payment ensures medications are affordable.

MBS items for First Nations health

MBS Item 715 (Health Assessment for Aboriginal and Torres Strait Islander persons) — comprehensive health check including weight, waist, dietary and activity assessment, chronic disease screening. Item 732 (follow-up). These items are bulk-billed and should be offered proactively at every opportunity.

Traditional food and activity

Where appropriate and desired by the patient, support access to traditional foods (bush tucker) and culturally relevant physical activities (traditional dance, hunting, fishing, walking on Country). These approaches reconnect patients with cultural identity and have demonstrated benefits for both physical and social-emotional wellbeing.

Children and families

Focus on family-based, whole-of-community approaches rather than individual child interventions. School-based nutrition programmes, community cooking classes, and structured sport/exercise programmes in partnership with ACCHOs and local councils show stronger engagement than clinic-only models. Avoid stigmatising children about weight.

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Key principle: Obesity management for Aboriginal and Torres Strait Islander peoples must be embedded within a strengths-based, self-determination framework. Health literacy interventions, food subsidy programmes (e.g., Northern Territory Stores Policy), and community-driven healthy lifestyle initiatives are more effective than clinic-based individual counselling alone. Always ask the patient about their priorities and preferred approach.

📚 References

1. Australian Institute of Health and Welfare. Overweight and obesity: an interactive insight. AIHW; 2023. Available from: https://www.aihw.gov.au
2. Royal Australian College of General Practitioners. Management of obesity in adults in general practice: a guide for GPs. RACGP; 2019.
3. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: NHMRC; 2013.
4. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: NHMRC; 2013 (updated 2024).
5. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–E891.
6. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384(11):989–1002.
7. Australian and New Zealand Metabolic Obesity Surgery Society (ANZMOSS). Position statement on bariatric surgery in Australia and New Zealand. ANZMOSS; 2022.
8. Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial (CROSSROADS). Lancet. 2021;397(10271):293–304.
9. Commonwealth Department of Health and Aged Care. Medicare Benefits Schedule Book — Category 1: Professional Attendances (Items 721, 723, 715, 732). Canberra: Australian Government; 2024.
10. Obesity Australia. No time to wait: securing the future health of Australians — obesity summit report. Obesity Australia; 2023.
11. Browne J, Walker T, Brown A, et al. Aboriginal and Torres Strait Islander health and wellbeing: socio-economic and cultural determinants. In: The Health of Indigenous Australians. Oxford University Press; 2023.
12. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures — 2019 update. Obesity. 2020;28(O1):S1–S58.
13. Bragg F, Tang K, Guo Y, et al. Associations of general and central adiposity with incident disease, mortality, and health outcomes: a prospective cohort study of 0.5 million Chinese adults. Lancet Diabetes Endocrinol. 2023;11(6):416–428.
14. Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol. 2020;75(2):235–251.

for PBS scripts. Utilise ACCHS pharmacies and Remote Area Aboriginal Health Worker programs for medication supply in remote areas. Avoid initiating benzodiazepines; support holistic pain management including community-based exercise programs.

Preventive health

Promote bone health: encourage vitamin D supplementation (1000 IU daily in deficient individuals), smoking cessation support, reduction of alcohol intake, and weight-bearing exercise. MBS Item 715 health checks provide a structured opportunity to assess bone health, screen for osteoporosis risk factors, and discuss musculoskeletal health in a culturally safe context.

Quick Reference: Differential Diagnosis at a Glance

Costovertebral dysfunction

Paracetamol ± NSAID; manual therapy

2–6 weeks

Provocable on palpation; no red flags

Thoracic compression fracture

Paracetamol; ± calcitonin; DXA + osteoporosis Rx

6–12 weeks healing

Elderly; osteoporosis; acute onset

ACS (posterior MI)

Aspirin 300 mg, GTN, heparin; urgent PCI

Time-critical

ECG, troponin; CV risk factors

Aortic dissection

IV labetalol; urgent CT aortogram; surgery (Type A)

Time-critical

Tearing pain; BP differential >20 mmHg

Vertebral osteomyelitis

IV antibiotics (vancomycin + ceftriaxone initially); ID consult

6 weeks IV antibiotics

Fever, elevated CRP, IV drug use

Biliary colic / cholecystitis

Paracetamol ± morphine; lap cholecystectomy

Surgical within 72 h (cholecystitis)

RUQ/infrascapular; post-prandial; RUQ US

📚 References

1. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
2. National Health and Medical Research Council (NHMRC). Evidence-based management of acute musculoskeletal pain. Canberra: NHMRC; 2003 (updated 2020).
3. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
4. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760–765.
5. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Europ Spine J. 2018;27(1):60–75.
6. Erwin WM, Jackson PC, Homonko DA. Innervation of the human costovertebral joint: implications for clinical back pain syndromes. J Manipulative Physiol Ther. 2000;23(6):395–403.
7. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th edn. Melbourne: RACGP; 2018 (updated 2023).
8. Hirsch JA, Singh V, Falco FJE, et al. Thoracic facet joint interventions. Pain Physician. 2016;19(4):E581–E593.
9. Erwin WM, Jackson PC. The costovertebral joint: anatomy, biomechanics, and clinical significance in thoracic back pain syndromes. J Can Chiropr Assoc. 2003;47(2):112–120.
10. Strayer RJ, Gunnerson JM, Brown LH, et al. Aortic dissection: clinical features, diagnosis, and management. Aust Crit Care. 2019;32(2):144–153.
11. Ombregt L. A system of orthopaedic medicine. 3rd edn. Edinburgh: Churchill Livingstone Elsevier; 2013. Chapter 18: Thoracic spine.
12. Lin CC, Chen KH, Li DM, et al. Characteristics and outcomes of patients presenting with thoracic back pain to the emergency department. Emerg Med Australas. 2020;32(5):805–811.

for PBS-listed medicines at participating pharmacies.

Cultural safety

Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.

Medication adherence

Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.

Specific conditions

Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.

Referral pathways

Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).

for PBS-listed medicines at participating pharmacies.

Cultural safety

Medication adherence

Specific conditions

Referral pathways

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).